On April 27, 2004, President George W. Bush proclaimed a bold goal for the nation: "Within the next 10 years, electronic health records will ensure that complete health care information is available for most Americans at the time and place of care, no matter where it originates. ... These electronic health records will be designed to share information privately and securely among and between health care providers when authorized by the patient."
More than 10 years later, most observers within the U.S. health care system and the health IT industry would agree that this goal of interoperability has not yet been achieved, and may not even be within clear sight. Although pockets of interoperability exist, the EHR systems used by inpatient, outpatient and ancillary providers generally cannot exchange patient data electronically, sometimes even among systems developed by the same EHR vendors. Although myriad interoperability standards exist on paper, real world connectivity between individual EHR systems still requires extensive custom interface development, attended by large and often prohibitive costs.